In their accompanying paper, Delaney and colleagues report a randomised controlled trial of 699 people with uninvestigated dyspepsia, which compares the strategy of “test and treat” for Helicobacter pylori infection against empirical acid suppression using a proton pump inhibitor.1 The test and treat group was tested for H pylori infection and positive patients were given eradication treatment, whereas negative patients were given proton pump inhibitors. Previous studies have looked at people who were H pylori positive2 or H pylori negative,3 but none has used test and treat as an overall strategy—instead, if patients were H pyloripositive they were randomised to eradication treatment or placebo; if they were negative they were randomised to proton pump inhibitors, other drugs, or placebo.

Dyspepsia is a common symptom complex of epigastric pain or discomfort—which includes symptoms of heartburn, acid regurgitation, excessive belching, increased abdominal bloating, nausea, feeling of abnormal or slow digestion, or early satiety—for which patients seek medical care.4 Upper gastrointestinal endoscopy should be performed in patients with alarm symptoms such as weight loss, vomiting, or overt bleeding. However, most patients can be safely managed with …